ویتامین ها و مواد معدنی

Vitamins and Mineral Supplements

In 1978, a six-year-old girl was admitted to the hospital with a serious gunshot wound. A long series of operations to repair her abdomen were performed and in the process, more than three meters of her gastrointestinal tract were removed, leaving her unable to digest food for months.

She had to survive on a form of liquid nutrition injected directly into the bloodstream called total parenteral nutrition - TPN. To avoid essential fatty acid deficiency, fat had to be supplemented to the TPN. The fat this hospital used in the girl’s TPN “meal” came from safflower oil, which is very rich in linoleic acid and low in alpha linolenic acid.

Over the following months, she gradually started to experience various neurological symptoms - the bottoms of her feet became numb, and this spread to her lower legs along with a dull pain.

She experienced episodes of drastic weakness and her eyesight became blurred. They then switched the girl over to a soybean oil supplemented TPN - soybean oil has 10 times more of the omega-3 fatty acid alpha-linolenic acid compared to safflower oil, and, after the switch, her symptoms slowly resolved.

This is one way the importance of omega-3 fatty acids came to light. The funny thing is, this injectable TPN solution kind of reminds me of the meal replacement Soylent. Silicon Valley entrepreneur Rob Rhinehart came up with the idea for Soylent sometime around 2013, when he figured you could just mixup all the nutrients the body needs in a shake and drink that instead of food.

The name comes from the 1973 movie Soylent Green where thanks to overpopulation, this smörgåsbord of food costs 279 dollars, strawberries are 150 bucks a jar, and Tuesday is Soylent green day, where you can get the miracle nutritious cracker-like food made of … people! We gotta stop-” Don’t worry, actual Soylent contains no people.

This brings up an interesting question: Is it OK to rely on a mixture of isolated nutrients to meet our body’s needs? I’m not referring to soylent, but multivitamins and supplements. Supplements have greatly benefited many people, helping them reach adequate levels of key nutrients, however Vitamins and minerals are confusing because there are a lot of complex interactions between them, and when you look at different supplement labels, you’ll see one lists Folate as Folic Acid where another lists it as L-5-Methyltetrahydrofolate.

Then, one might be providing Vitamin A as beta carotene where another provides it as retinyl palmitate and so on.

The point of this video is to educate and hopefully confuse you enough to get you more curious about supplements so you’ll take a more organized approach to using them, rather than just taking a multivitamin and calling it a day. “Want to grow?

The calcium in milk helps bones grow.” Let’s start with calcium. It’s supposed to be good for our bones, so we ought to make sure and get plenty of it. What’s great is dietary calcium has been shown to be inversely related to heart disease and kidney stones.

However, the opposite is true for calcium supplements. Here is Doctor Ian Reid presenting data on the effect of calcium supplementation on heart attacks. They were expecting extra calcium would be preventative of heart attacks, and here we do see a nice statistically significant separation of the two lines of data for subjects on calcium supplements and subjects on placebo.

The only problem is… the lines separated in the wrong directions. Calcium supplementation increased the risk for heart attack. As for potential mechanisms behind this, In the 8 hours after you take a calcium supplement, your blood calcium shoots up.

Two important consequences of a calcium supplement is that it raises your blood pressure and the coagulability of the blood goes up - it makes your blood clot more. The primary risk factors for cardiovascular disease - obesity, diabetes, smoking and so on are linked to platelet activation and clotting.

Calcium supplements are an example of why it’s good to rely on food for nutrients by default. Supplementing calcium sounds like a good idea at first, but it took years of data to find out that it’s not.

Similar to the earlier story of the little girl in the hospital lacking omega-3 fatty acids, Choline, found in things like broccoli and egg yolks, was another thing missing for a while from intravenously delivered nutrition.

Unfortunately the consequence of leaving choline out of IV nutrition was that the subjects often developed fatty liver. It was found in 1995 that choline deficiency results in fatty liver and that choline supplementation reverses it.

Choline wasn’t officially recognized as an essential nutrient by the Institute of Medicine until 1998. The point here, is that in nutrition, assuming we have all the pieces to the puzzle has gotten us in trouble - another reason to rely on whole natural foods by default because they may contain important substances we are not yet familiar with.

There are some caveats though. “If you eat just one carrot every day, that provides all the Vitamin A you need to survive.” Derek Muller of Veritasium recently talked about vitamins in a well produced and very interesting documentary called Vitamania.

While he may be correct that you can survive on the vitamin A from 1 carrot a day, it’s very unlikely that this is optimal. This is because carrots don’t contain Vitamin A but a carotenoid called beta carotene which is a “provitamin” - a substance that can be converted into a vitamin.

According to this book from the Us Institute of Medicine Panel on Micronutrients, beta carotene has 1/12 the vitamin Activity of proper Vitamin A - retinol. This study found that the bioefficacy of beta-carotene from a mixed diet is only 1:21. This is mostly because the beta carotene is bound up in a hard to digest fiber matrix.

Carrots have other carotenoids, but for beta carotene, you’d actually absorb about 7 times more beta-carotene if you took it suspended in oil. So why in oil? Vitamin A is a fat soluble vitamin, you need fat to absorb and assimilate it properly.

So it makes sense that this research from Ohio state found that avocado is a good way to help absorb carotenoids like beta-carotene and convert them to Vitamin A. More than 12 times as much vitamin A was formed from carrots when eaten with avocado than without it.

On the other hand, this study concluded that β-carotene conversion to Vitamin A, even when measured under controlled conditions, can be surprisingly low and variable. This could be due to genetic differences - In fact, spitting in a tube has taught me that I don’t convert beta-Carotene very well, by about 32% or so.

This is because of a particular single nucleotide polymorphism on my BCMO1 gene. One last thing, the absorption efficiency of carotenoids decreases as the amount of dietary carotenoids increases, so it’s doubtful that you can just cram down more and more carrots to get optimal Vitamin A levels.

Carotenoids like beta-carotene have their own functions other than just conversion to Vitamin A, so it’s good to have them in the diet, but you wouldn’t want to rely on the provitamin beta-carotene to meet your Vitamin A requirements.

It would be better to get your vitamin A from fish roe or cod liver oil, good quality egg yolks, liver, rather than beta carotene. And when you eat carrots, eat them with some butter or maybe an avocado. Another example of form being important is when you’re getting your folate.

This also comes up in the Vitamania documentary - it seemed that due to insufficient folate, Kim Robbins was born with a hemangioma on his back which turned out to be a neural tube defect - effectively a hole in his spinal column. This leaves him spending most of his time in a wheelchair.

He also has spasm-like back pain give or take 200 times a day. To prevent neural tube defects, mothers need to have sufficient folate levels before the start of pregnancy. For this reason, In 2009, Australian bread began being fortified with folic acid. It must be added to all wheat flour for bread making.

A worthwhile effort, it seems, as the rate of neural tube defects has halved. However, the case on this is not quite closed. As this review points out “a substantial proportion of women who take folic acid supplements [before pregnancy] [still] give birth to Neural Tube Defect-affected infants.” Dr. Benjamin Lynch, author of “Dirty Genes” has done an excellent job explaining why this may be the case.

You see, similar to our earlier discussion with beta carotene and vitamin A, “folic acid” is not folate. Folic Acid is synthetic and must be converted to 5-MethylTetraHydroFolate or just “methylfolate” to be useful - methylfolate the actual vitamin that gets things done. And a crap ton of work has to be done to transform folic acid into methylfolate.

It was thought that folic acid would be a great supplement for humans because of studies done on rats showing that their DHFR enzyme, the first step in transforming folic acid into methylfolate, works very efficiently.

However, the efficiency of this enzyme in actual humans is way lower. The title of this paper describes the human DHFR enzyme activity as being“extremely slow and variable.” This leads to the DHFR enzyme being overloaded and a lot of unmetabolized folic acid is left floating around - but folic acid itself isn’t useful for anything unless it’s been transformed. And it’s being transformed at a very slow rate.

The downside of this is not just that folic acid is an inefficient way to up your folate levels, but that folic acid for some reason is much more rapidly absorbed than natural folates. And, the folate receptor has a much higher affinity, a much higher preference for folic acid than the actually useful methyl-folate.

“So the folate receptor prefers folic acid getting all stuck to it than methyl folate. Whoa, that’s a huge problem. I prefer methylfolate binding to my folate receptor, thank you.. I don’t want folic acid being stuck on there, why?

Because it doesn’t do anything! It’s not physiologically active. Folic acid blocks the physiological effect of methylfolate. You want methylfolate binding to your receptor, you don’t want that crap sitting on it.” This phenomenon Dr. Lynch is talking about is echoed in this paper: “The transport of folates into the brain is carried out by the folate receptor in the choroid plexus, so the folic acid in the blood might inhibit the transport of methyl-THF into the brain.”

This is a complex topic with much more to be said, but the point is in order to maintain optimal folate levels, you’d want to avoid folic acid and get your folate from leafy greens, liver or if you need to use a supplement, make sure the supplement label says something like 5-MethylTetraHydroFolate or 5-MTHF or methyl-THF or just methyl-folate.

Folinic acid is another option I didn’t have time to discuss, but see the description for more information on that. One last point is that of balance. I think the Omega-6 to Omega-3 balance has gotten a lot of attention lately.

According to this 2002 paper, “human beings evolved on a diet with a ratio of omega-6 to omega-3 essential fatty acids of approximately 1 to 1 whereas in Western diets the ratio is between 15 to 1 and 16.7 to 1.” So The idea of all these new omega-3 products on the market is to improve this ratio, but it doesn’t matter if you get a bunch of omega 3 if you keep getting a bunch of omega-6.

Another good strategy would be to reduce your omega-6 intake. Similarly many other things need to be in balance. For example, Vitamin A and D. This paper found that when giving turkeys extremely high doses of vitamin A and normal doses of vitamin D the turkeys had symptoms of hypervitaminosis A, vitamin A toxicity.

But When they gave high vitamin D and normal vitamin A, they got hypervitaminosis D. But when they got extremely high levels of both vitamins, no symptoms showed up - the results were no different from controls.

There are several other examples of this, but a great example of how complex this can get is the interactions between the various minerals. Take a look at this little diagram. This shows up in Passwater and Cranton’s book “Trace Elements, Hair Analysis and Nutrition” and they call it the mineral wheel.

If you have too much of one mineral, it could cause a deficiency in whatever mineral its arrow is pointing to. So excess cobalt could cause iron deficiency, excess copper could deplete zinc and so on.

The point of this isn’t to scare you, but just to have you consider things like : look at your copper intake if you supplement zinc or consider your potassium or phosphorus levels if you want to correct an iron deficiency and so on.

So, to sum all this up, Pay attention to the form of supplement you’re getting and how it’s absorbed Look at how vitamins and minerals interact with each other so don’t throw yourself off balance And, if you can, try to default to getting your nutrients from whole foods.